tbuckley/cabot-search huggingface dataset:
Evaluating the time toxicity of cancer treatment in the CCTG CO.17 randomized clinical trial (RCT).
Authors: Arjun Gupta, Christopher J. O'Callaghan, Liting Zhu, Derek J. Jonker, Ralph Wong, Bruce Colwell, Malcolm J Moore, Christos Stelios Karapetis, Niall C Tebbutt, Jeremy David Shapiro, Dongsheng Tu, Christopher M. Booth
Journal: Journal of Clinical Oncology (2022)

248 Background: Most individual treatments for advanced cancer are associated with modest survival benefits. The time spent in pursuing these treatments can be substantial. We have previously developed a pragmatic and patient-centered metric of these time costs, which we term ‘’time toxicity’’, as any day with physical healthcare system contact. This includes outpatient visits (e.g., for bloodwork, scans, infusions, urgent care), emergency room visits, and overnight stays in a healthcare facility. Herein we sought to assess time toxicity in a completed RCT. Methods: We conducted a secondary analysis of the Canadian Cancer Trials Group CO.17 RCT that evaluated weekly cetuximab infusions vs supportive care alone in 572 patients with advanced colorectal cancer. CO.17 recruited participants in Canada, Australia and New Zealand. Initial results reported a 6-week improvement in median overall survival (OS) with cetuximab (6.1 vs 4.6 months, p = 0.005). Subsequent analyses reported that OS benefit was restricted to and significantly more in patients with K-ras wild-type tumors. We calculated patient-level time toxicity by analyzing treatment, follow-up, and resource utilization forms. We considered a day without physical healthcare contact as a ‘’home day’’. Thus, for a patient, OS was time toxic days + home days. We compared medians of time measures across arms, and stratified results by K-ras status. Results: In the overall population, median time toxic days were higher in the cetuximab arm (28, vs 10, p &lt; 0.001), although median home days were not statistically different (140, vs 121, p = 0.09). The proportion of time toxic days (time toxic days/OS) were significantly more with cetuximab (18%, vs 6%, p &lt; 0.001). Of the 28 time toxic days in the overall cetuximab arm, 14 (50%) were protocol-related (e.g., scheduled infusions etc). Stratified results are in the table. Conclusions: Time toxicity can be extracted through secondary analyses of RCTs. In CO.17, despite an overall OS-benefit with cetuximab, home days were statistically similar across arms. In the K-ras-mutated group, cetuximab was associated with numerically similar OS but more time toxic days. In the K-ras-wild type group, cetuximab was associated with higher home days. Thus, time toxicity data need not always be sobering. Time toxicity measures can supplement traditional survival endpoints in RCTs to guide patient-oncologist decision-making. Cooperative group RCTs are well positioned for such analyses. Clinical trial information: NCT00079066. [Table: see text]
Predictors of compliance with payer-led oncology clinical pathways.
Authors: Samyukta Mullangi, Xiaoxue Chen, Timothy Pham, Ying Liu, Aliza Gordon, David Joseph Debono, Michael Jordan Fisch, Mithat Gonen, Dawn L. Hershman
Journal: Journal of Clinical Oncology (2022)

7 Background: Rising healthcare costs have garnered interest from payers in shifting oncology care towards a value-based practice model. Pathways are a subset of evidence-based guidelines designed to standardize cancer drug prescribing by clarifying decisions along three priorities: efficacy, safety, and cost. However, the major predictors of compliance with clinical pathway recommendations are unknown. Methods: We conducted a retrospective cohort study using administrative claims linked with prior authorization data of Anthem commercial and Medicare Advantage members. We identified members aged 18 or older with a diagnosis of breast, lung, colorectal, bladder, kidney, uterine, pancreatic cancer or melanoma being treated with a first-line treatment regimen in the metastatic setting between July 2018 and October 2021. The primary outcome was pathway compliance (PC), defined as whether a patient’s anti-cancer drug regimen is also an Anthem pathway-endorsed regimen. We built a logistic regression model with stepwise backward selection to identify patient, physician, practice, geographic, and temporal factors that were associated with PC. Results: The cohort comprised 17,584 patients in total. The treatment period yielded 11,277 (64%) observations of patients with PC (48.1% male, mean [SD] age 60.7 years [11]) and 6,307 (36%) without PC (45.1% male, mean [SD] age 60.4 years [11.6]). In adjusted analyses, we find that the odds of PC decrease over time and with variation by malignancy. Any inpatient (OR = 1.32, 95% CI 1.22 – 1.43) or emergency room utilization (OR = 1.21, 95% CI 1.12 – 1.31) in the baseline 6-month period was associated with a higher odds of PC. Conversely, doubling total medical costs in the preceding 6 months was associated with lower odds of PC (OR 0.86, 95% CI 0.83 – 0.88). The odds of PC increased with a higher share (median or above vs below median) of Anthem patients per physician (OR 1.12, 95% CI 1.04 – 1.20). Finally, Oncology Care Model participation was associated with higher odds of PC (OR = 1.13 95% CI 1.04 – 1.23). Conclusions: Among patients treated in the first-line setting for metastatic disease, PC was observed in slightly under two-thirds of cases and was associated with the penetration of Anthem patients in the practice. Participation in OCM was also associated with increased PC. These findings would be of interest to policymakers focused on value-based cancer care.
Improving comprehensive genotyping in patients with newly diagnosed non-squamous NSCLC: Results from a prospective trial of a behavioral nudge intervention.
Authors: Charu Aggarwal, Erica L. Carpenter, Dylan G. Scholes, Wei-Ting Hwang, Tara McWilliams, Aditi Puri Singh, Lova Sun, John A. Kosteva, Michael Robert Costello, Abigail Doucette, Peter Edward Gabriel, Megan Roy, Anthony O. Martella, Jeffrey C. Thompson, Roger B. Cohen, Corey J. Langer, Lawrence N. Shulman, Melina Elpi Marmarelis
Journal: Journal of Clinical Oncology (2022)

362 Background: Despite current guidelines, less than 50% of patients with metastatic (m) non-squamous (NSq) NSCLC undergo comprehensive molecular genotyping. At our institution, based on improved comprehensiveness of genotyping with use of concurrent tissue (T) and plasma (P) next generation sequencing (NGS), we designed an electronic medical record (EMR)-based nudge intervention to auto-generate an order for P NGS at the time of initial consultation, while T NGS was carried out reflexively based on institutional pathways. Methods: A prospective study was conducted at the Abramson Cancer Center and 2 community sites within the University of Pennsylvania Health System after IRB approval. A provider team-focused EMR-based nudge intervention was designed to order P NGS at the time of new patient consultation. Eligible patients for the nudge were identified using an EMR based checklist, that included 3 criteria i. newly diagnosed, ii. treatment naïve, iii. mNSq NSCLC. Results from the intervention period (4/2021-12/2021) were compared to baseline data from similar patients treated at our institution between 01/2019 and 03/2021. Categories of NCCN guideline recommended molecular genotyping were defined as: i) comprehensive: EGFR, ALK, BRAF, ROS1, MET, RET, NTRK testing, and ii) incomplete or no testing performed. The proportion of patients with comprehensive molecular genotyping prior to 1st-line therapy were compared in the pre- and post-intervention groups using the chi-square test. Results: 526 patients with mNSq NSCLC were included in this analysis: 381 in the pre-intervention cohort, 145 in the post-intervention cohort. After implementation of the EMR-based nudge, a higher proportion of patients underwent concurrent T+P testing resulting in improved comprehensive molecular genotyping. In addition, a greater proportion of patients had comprehensive genotyping available prior to 1st-line therapy in the post-intervention vs pre-intervention cohort (Table). Conclusions: Across 3 practice sites, a provider team-focused EMR-based nudge intervention was associated with a significantly higher proportion of patients with mNSq NSCLC undergoing comprehensive molecular genotyping, both overall and prior to 1st-line therapy. These findings demonstrate that behavioral, EMR-based nudges can promote guideline concordant diagnostic testing at both community and academic sites and should be studied further as a tool to improve rates of molecular testing in NSCLC.[Table: see text]
Provider-led advance care planning in community oncology: A successful multidisciplinary quality improvement intervention.
Authors: Sandhya Mudumbi, Leah Owens, Christy L Schneider, Susan A Frailley, John Arrowsmith, Pam Waddell, Kim Vanatta, Larry Edward Bilbrey, Kathleen L Murphy, L. Johnetta Blakely, Stephen Matthew Schleicher, Natalie R. Dickson
Journal: Journal of Clinical Oncology (2022)

209 Background: Advanced care planning (ACP) is an important aspect of shared decision making in cancer treatment. Due to its importance, in 2016, Medicare expanded coverage and reimbursement for advance care planning (ACP) services (CPT codes 99497 and 99498). Despite this, ACP has been underutilized in practice. Methods: Tennessee Oncology aimed to increase knowledge and utilization of this service by medical oncologists and advance practice providers and corresponding CPT codes through an educational and quality improvement project. We formed a multidisciplinary team with individuals representing medical oncology providers, palliative care team, billing and accounting, information technology and informatics, nursing, navigation team, and operations. This team created an educational video, incorporating the “PAUSE” framework for addressing advance care planning and its role in community oncology, and details of documentation and billing. We also built in documentation templates into the medical oncology note and created a process to automate the charge capture to avoid additional steps for oncology providers. Results: Prior to this initiative, there was no baseline method to measure ACP and corresponding documentation. After two months of launching our educational video and new documentation templates, 120 documented ACP discussions were completed. ACP documentation was performed by 61 total providers practicing across 16 clinics. Providers completing documentation included both medical oncology (n = 53, 86%) and palliative care (n = 8). Of medical oncology providers, 39 (73%) were physicians and 14 (27%) were advanced practice providers. The three most common cancer diagnoses in ACP encounters were lung (20%), breast (13%), and prostate (8%). Conclusions: This combination of education and automation with multidisciplinary team input helped establish a baseline for ACP measurement that will help identify gaps and improve ACP discussions and documentation in our practice going forward.
Real-world tolerability of biosimilar bevacizumab-awwb compared to bevacizumab in patients with cancer at an academic medical center.
Authors: Maher Alhaja, Candy Tsourounis, Hansen Ho, Richard Fong
Journal: Journal of Clinical Oncology (2022)

322 Background: Bevacizumab-awwb and bevacizumab are vascular endothelial growth factor (VEGF) inhibitors that are commonly combined with other oncolytic agents for the treatment of various malignancies. Real-world outcomes and financial impact of biosimilar use are limited, particularly for oncologic indications. In patients with non-small cell lung cancer, bevacizumab-awwb and bevacizumab demonstrated similar clinical efficacy and safety. Bevacizumab-awwb outcomes in other cancer subtypes are lacking. The purpose of this study is to compare the safety and financial impact associated with the utilization of biosimilar bevacizumab-awwb vs bevacizumab. Methods: This is an IRB-approved, single-center, retrospective cohort study including adult cancer patients who were initiated on bevacizumab-awwb or bevacizumab between June 2019 and May 2021. Eligible patients for bevacizumab-awwb treatment must have been naïve to bevacizumab treatment. Patients switching from bevacizumab to bevacizumab-awwb or participating in clinical trials were excluded. Common Terminology Criteria for Adverse Events Version 5 was used for safety outcomes assessment. The primary safety outcome was new-onset, grade ≥ 2+ hypertension (HTN). The secondary safety outcomes include grade ≥ 2+ proteinuria, hemorrhage, and gastrointestinal perforation, and cost using the average wholesale price for drug acquisition. Results: In this study, 377 patients were included with 200 Bevacizumab and 177 Bevacizumab-awwb patients. There were 11 cancer types with similar baseline characteristics among both groups except for ovarian and hepatocellular carcinoma. Although there was no significant difference in grade ≥ 2+ HTN, initiation of new antihypertensive therapy was found to be greater in the bevacizumab arm (p = 0.002). Grade 2 proteinuria was observed to be lower in the Bevacizumab-awwb arm (p = 0.01). There were no significant differences in other safety outcomes. In 2020, bevacizumab-awwb utilization accounted for 34% of bevacizumab orders, saving $167,000. If bevacizumab-awwb utilization increased to 75%, approximately $400,000 can be saved per year. Conclusions: In this real-world analysis, bevacizumab-awwb demonstrated a comparable safety profile to bevacizumab in regards to grade ≥ 2+ hypertension, proteinuria, hemorrhage and gastrointestinal perforation regardless of primary cancer type. Replacing Bevacizumab for Bevacizumab-awwb lowered drug acquisition costs.
Screening for supportive care services in the neuro-oncology patient: A quality improvement project.
Authors: Katherine S. Cermin, Mary Salazar, William Kelly
Journal: Journal of Clinical Oncology (2022)

355 Background: On average, 80 to 85% of patients diagnosed with brain tumors qualify for supportive care under the American Society of Clinical Oncology (ASCO) recommendations. The National Comprehensive Cancer Network (NCCN) recommends routine screening, yet in our experience only 39% are screened in-clinic and 8.7% qualifying are referred. Evidence within the literature suggests consistent patient symptom screening and reflexive supportive care referral leads to improved quality of life and treatment plan adherence, and reduced symptom burden, healthcare costs, and less aggressive end-of-life care. This QI/IS project sought to improve quality of life through increased symptom screening via the Edmonton Symptom Assessment Scale (ESAS) and initiation of supportive care referral in Neuro-Oncology patients. Methods: Institutional Review Board (IRB) appraisal deemed this project non-regulatory research. A retrospective chart review assessed pre-implementation consistency of patients screened using the ESAS tool, the number indicating symptom burden and supportive care qualification, and if referral was placed. The Plan-Do-Study-Act (PDSA) Framework guided implementation and process evaluation. Interventions focused on improving ESAS use to identify patients who would benefit from supportive services and decreasing barriers to supportive care such as supportive care misinformation, screening burden, and documentation. From October 2021 to March 2022, data collection included the patient demographics ethnicity, age, diagnosis, and encounter date, as well as patient ESAS scores and supportive care referrals placed. Results: Over a five-month implementation period, 357 ESAS symptom burden tools were completed and documented out of 378 patient encounters in the neuro-oncology outpatient clinic. Clinic ESAS completion rates increased from 39.3% to 94.4%. Symptom burden qualifying for supportive care referral improved in 18% (N = 66), down from 31.2% (N = 102) of patients. Of patients qualifying, referrals increased from 4.9% (N = 5) to 10.7% (N = 7). Conclusions: Consistent use of a patient screening process led to an increase in the number of identified patients with significant symptom burden and referral for supportive care services, meeting all project goals. Initially, qualified rates increased with improved screening processes and clinic education, then steadily decreased to indicate better symptom control. This suggests a process capable of meeting the screening needs of oncology patients and minimal resource needs to maintain long-term sustainability. Future projects aimed at supportive care access and resource availability are recommended.[Table: see text]
Association of prevalent social risks with treatment initiation among patients with cancer.
Authors: Ana I. Velazquez Manana, John F. Dickerson, Matthew P. Banegas
Journal: Journal of Clinical Oncology (2022)

137 Background: Social risks are adverse conditions that may serve as barriers to health care and lead to poor health outcomes. Among individuals with cancer, social risks like financial hardship have been associated with delayed treatment and increased mortality. However, little is known about the association of multiple prevalent social risks with cancer treatment initiation. In this study, we assessed the prevalence of social risks at time of cancer diagnosis and their association with treatment initiation. Methods: Data from patients aged ≥18, enrolled at Kaiser Permanente Northwest, diagnosed with cancer between June 1, 2017-December 31, 2019 and screened for social risks within 90 days pre-cancer diagnosis (baseline) were included. Baseline social risks included financial hardship, food insecurity, housing instability, and transportation difficulties. Cox proportional hazards regression models were used to assess the outcome of time to treatment initiation. Patients were censored at disenrollment or end of the study observation (February 29, 2020). Separate models were used to measure associations of any baseline social risks and time-to-treatment, each individual social risk, and a combined model with all 4 social risk variables. Confounding was controlled propensity score overlap weighting, estimated as a function of age at diagnosis, sex, race/ethnicity, Elixhauser comorbidity index, education, household income, NDI, cancer type, stage, and days from social risk assessment to cancer diagnosis. Results: Among the 549 patients, 49% were female and the mean age was 66 years (SD = 14). 105 (19%) patients reported any baseline social risk. The most common prevalent social risk was financial hardship (12.8%), followed by housing instability (9.1%), food insecurity (6.4%), and transportation difficulties (5.7%). In separate adjusted models, presence of any baseline social risk was associated with lower risk of treatment initiation (HR = 0.69, p = 0.040) and financial hardship was associated with lower risk of treatment initiation (HR = 0.63, p = 0.032). Conclusions: This study provides evidence that social risks at the time of cancer diagnosis are associated with lower risk of treatment initiation. Among individual social risks, financial hardship was a major barrier to initiation of cancer treatment. Our findings highlight the importance of screening for and addressing social risks at time of cancer diagnosis to reduce the risk of poor cancer care and subsequent health outcomes.
John Millie Dow Galloway
Authors: Alan Wilkinson, Peter Galloway, Peter Lee
Journal: BMJ (2022)

<h3>Objective</h3> To explore primary care polymyalgia rheumatica (PMR) patient beliefs about the causes of their PMR. <h3>Design</h3> Qualitative content analysis was conducted on patients9 written responses to the question of what they thought had caused their PMR. All data were coded and emergent categories of causal beliefs identified. <h3>Setting</h3> Community patients receiving primary care at general practitioner (GP) practices across England. <h3>Participants</h3> Participants were recruited from a primary care PMR inception cohort (n=654). Between June 2012 and June 2014 GPs referred 739 people with a new PMR diagnosis in the past 3 years into the study. Patients were mailed a baseline self-completion questionnaire, which included the question, ‘What do you think caused your PMR?’. Responses to this question form the data set for the present study. <h3>Results</h3> 296 (45%) patients gave a possible cause for their PMR, while 276 (42%) respondents wrote ‘no idea’. Common attributions include ageing (45, 18%), medication (18, 5%) and personal stress (53, 14%). 24 respondents (6%) thought their PMR was as a result of another medical condition. <h3>Conclusions</h3> This is the first study to examine causation beliefs in PMR, identifying a number of possible causes such as ageing, stress and as a complication of other medical problems. Understanding these patient beliefs may impact on treatment adherence and patient outcome.
UK childhood vaccination rates fell last year in almost all programmes, figures show
Authors: Gareth Iacobucci
Journal: BMJ (2022)

Vaccination coverage for young children fell last year in 13 out of 14 routine programmes across the UK, new data have shown. The UK Health Security Agency (UKHSA) urged parents and guardians to ensure their children are up to date with all their routine childhood immunisations, warning that children faced serious health risks from missing them. In 2021-22 no vaccinations met the 95% target set by the World Health Organization. The latest statistics1 by UKHSA and NHS Digital for UK children up to 5 years of age show that in 2021-22:
WORD: A large scale dataset, benchmark and clinical applicable study for abdominal organ segmentation from CT image
Authors: Xiangde Luo, Wenjun Liao, Jianghong Xiao, Jieneng Chen, Tao Song, Xiaofan Zhang, Kang Li, Dimitris N. Metaxas, Guotai Wang, Shaoting Zhang
Journal: Medical Image Analysis (2022)
Clinical and Prognostic Impact of Copy Number Alterations and Associated Risk Profiles in a Cohort of Pediatric B-cell Precursor Acute Lymphoblastic Leukemia Cases Treated Under ICiCLe Protocol
Authors: Sanjeev Kumar Gupta, Minu Singh, Pragna H. Chandrashekar, Sameer Bakhshi, Amita Trehan, Ritu Gupta, Rozy Thakur, Smeeta Gajendra, Preity Sharma, Sreejesh Sreedharanunni, Manupdesh S. Sachdeva, Deepam Pushpam, Neelam Varma, Deepak Bansal, Richa Jain, Srinivasan Peyam, Anthony V. Moorman, Prateek Bhatia
Journal: HemaSphere (2022)

Copy number alteration (CNA) status and CNA risk profiles of IKZF1plus , UK-ALL CNA risk groups and MRplus scores, were evaluated for clinical and prognostic impact in a cohort of 493 B-cell acute lymphoblastic leukemia cases diagnosed and treated under the Indian Collaborative Childhood Leukemia group (ICiCLe) protocol trial. Overall CNA frequency was 59% with 60% of cases showing 2-loci deletion. CDKN2A/B deletion was most common CNA (36.3%), while IKZF1 deletion and IKZF1plus profile were noted in 19.5% and 13.4% of cases, respectively. IKZF1 deletions and other CNA risk profiles were significantly associated with poor (PR)/high risk (HR) clinical and genetic profile parameters (P < 0.001). In addition, the 3-year OS, event-free survival (EFS) was significantly poor with high relapse rate (RR) of 38.6%, 46.5%, and 35.2% for IKZF1 deletions, IKZF1plus profiles, and UK-ALL CNA-intermediate risk (IR)+PR risk groups, respectively (P < 0.001). Integrated evaluation of UK-ALL CNA risk profile with ICiCLe trial risk stratification groups revealed a worse overall survival, EFS, and RR of 63.3%, 43.2%, and 35.2% for CNA-IR+PR profile compared to CNA-good risk profile (81.3%, 65.0%, and 21.0%; P < 0.001). Hence, routine CNA testing in our setting is must to identify standard risk and IR cases likely to benefit from HR treatment.